Mediterranean Diet Is a Predictor of Progression of Subclinical Atherosclerosis in a Mediterranean Population: The ILERVAS Prospective Cohort Study

Abstract

Atherosclerotic cardiovascular disease remains a major health issue, often developing silently as subclinical atherosclerotic disease (SAD). The Mediterranean diet (MDiet) is known for its cardiovascular benefits, but the combined influence of both MDiet adherence and physical activity (PA) on SAD progression has not been previously documented. Objective: We aimed to investigate how adherence to a healthy lifestyle, defined as MDiet adherence and PA level, influences SAD progression in subjects from the ILERVAS cohort follow-up. Methods: A study on 3097 participants from the ILERVAS prospective cohort was conducted. MDiet adherence was assessed using the MEDAS score, and PA categories were established using the IPAQ, both categorized into low, moderate, and high levels. Two different lifestyle scores integrating the MDiet and PA categories were built. The presence of atherosclerotic plaques was assessed by carotid and femoral ultrasound examination. Demographic, clinical, and biochemical data were also obtained. Multivariable linear, logistic, and Poisson regression models adjusted for potential confounders were used to analyze the association between the lifestyle scores and SAD progression, as well as the MDiet and PA as separate variables and number of territories with plaque. Results: A healthier lifestyle score did not show an effect on SAD progression. However, a higher MEDAS score was associated with a 3% decrease in the number of territories with plaque (IRR 0.97, 95% CI 0.96–0.99, p < 0.001), suggesting a protective effect of the adherence to the MDiet. PA did not show a significant association (IRR 1.00, 95% CI 1.00–1.00, p = 0.269). Older age, hypertension, dyslipidemia, smoking, and lower eGFR were associated with SAD progression, while the female sex was protective (IRR 0.67, 95% CI 0.63–0.72, p < 0.001). Conclusions: The findings of this study show that higher adherence to the MDiet is associated with reduced incidence of SAD, indicating its potential role in cardiovascular prevention strategies. Although a higher lifestyle score or physical activity levels did not show any significant effect, promoting the MDiet, alongside managing traditional cardiovascular risk factors, could be an effective public health intervention to prevent atherosclerosis and reduce the burden of cardiovascular disease.

This research was supported by the CIBER-Consorcio Centro de Investigación Biomédica en Red-(CB15/00071), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Spain. M.I.R.-L. holds a predoctoral grant SLT017/20/000107 from Pla Estratègic de Recerca i Innovació en Salut (PERIS) 2021–2024 of Generalitat de Catalunya. JJ has received financial support from the Agencia Estatal de Investigación (MCIN/AEI/10.13039/501100011033 and the European Union “NextGeneration EU”/PRTR) within the action “Consolidación Investigadora 2022” (CNS2022-135559) and Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III (Madrid, Spain), grant PI21/00770 (to J.J.), FEDER “Una manera de hacer Europa”. M Bermúdez-López holds a postdoctoral grant funded by the Ministerio de Ciencia, Innovación y Universidades (IJC2018-037792-I). This research was also funded by the Ministerio de Ciencia, Innovación y Universidades (grant PID2023-152233OBI00, co-funded by the European Regional Development Fund, “A way to build Europe”), and the Generalitat of Catalonia: Agency for Management of University and Research Grants (2021SGR00990) and Department of Health (SLT002/16/00250) to R.P. This work was supported by grants from the Diputació de Lleida, Instituto de Salud Carlos III (RETIC RD16/0009/0011). This work was also supported by the Grant PID2021-122952OB-I00 funded by AEI 10.13039/501100011033 and by ERDF A way of making Europe; the Networking Biomedical Research Centre in the subject area of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), initiatives of Instituto de Investigación Carlos III (ISCIII); ISCIII (grant AC22/00035); and the CERCA Programme/Generalitat de Catalunya. B2SLab is certified as 2021 SGR 01052. Institut d’Investigació Biomèdica Sant Pau and Biomedical Research Institute’s Dr. Pifarré Foundation from Lleida (IRBLleida) are accredited by the Generalitat de Catalunya as Centre de Recerca de Catalunya (CERCA).